Appendix B (part 1):

Responses to Each Survey Question

Our Concerns About Pain

How much do you agree with the following statements?

How much do you agree with the following statements?

What We Hope For

How Important would the following be to you?

How Important would the following be to you?

How Important would the following be to you?

How Important would the following be to you?

How Important would the following be to you?

How Important would the following be to you?

How Important would the following be to you?

What Type of Support We Want and By Whom

What type of support would you want if you were dying?

What type of support would you want if you were dying?

(Average of types of support)

Who would you want to provide you support if you were dying? (Average of who provides support)

Hospice Knowledge

Hospice Knowledge

Does Medicare pay for hospice services?

Heard a lot about hospice services (N=146)

If you were dying, would you want hospice support?
Heard a lot about hospice services (N=146)

Where would you want to receive hospice support?
(N=146, Heard a lot about hospice)

Would you be interested to hear more about hospice services?

Spirituality

Religious/Spiritual

How often do you attend religious or spiritual services?

How often do you find strength in your religion or spirituality?

Health

In general, how would you rate your own health right now?

Number of times in last 12 months received services at emergency room.

Number of times in last 12 months have seen a doctor?

Do you or any member of
your household have a serious chronic illness?

Are you currently covered by any health care insurance or program?

In the last 12 months, about how much did you spend each month out of your own pocket for doctor visits & prescriptions?